Proximal Femur Fractures - by Jeffrey Shyu, MD
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An educational presentation on the types, imaging features, and management of proximal femur fractures.
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Proximal Femur Fractures - by Jeffrey Shyu, MD
- 1. Proximal Femur Fractures Jeffrey Shyu, MD
- 2. Learning Objectives Provide an intuitive understanding of the morphologic types, injury mechanisms, and classification systems of adult proximal femur fractures, using multimodality imaging examples, 3-D models, and animations. Review the potential complications and management. Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 3. Proximal Femur Fractures: Organization Tree * Basicervical fractures, although intracapsular, are managed like intertrochanteric fractures. Proximal Femur Fractures Femoral Head Osteochondral Subchondral Extracapsular Intertrochanteric Greater Trochanter Lesser Trochanter Subtrochanteric Intracapsular Basicervical* Transcervical Subcapital Proximal femur fractures may be divided into femoral head, intracapsular femoral neck, and extracapsular fractures. Accurately categorizing the anatomic location and subtype of the fracture has significant implications for surgical management. Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 4. osteochondral fracturesubchondral fracturesubcapital fracturetranscervical fracturebasicervical fractureintertrochanteric fracturegreater trochanter fracturelesser trochanter fracturesubtrochanteric fracture Proximal Femur Fractures Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 5. Anatomy MOVIE: Computer generated tour of the relevant muscular, ligamentous, labral, and bony anatomy of the hip. Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 6. Anatomy The hip is a synovial joint with wide range of rotational motion and stability Stability is conferred by its ball and deep socket configuration, acetabular labrum, a strong joint capsule, articular cartilage, and surrounding muscle One of the few inherently stable joints because of its bony anatomy Iliofemoral and pubofemoral ligaments cover hip joint anteriorly. Ischiofemoral ligament covers hip joint posteriorly Byrne DP et al. The Open Sports Medicine Journal 2010 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 7. Anatomy: Arterial Supply Medial femoral circumflex artery ⢠Largest, most important contributor ⢠Posterior portion of vascular ring ⢠Supplies superolateral femoral head Lateral femoral circumflex artery ⢠Anterior portion of vascular ring ⢠Supplies inferoanterior femoral head Obdurator artery ⢠Via ligamentum teres ⢠Little supply to femoral head, inadequate in setting of displaced head/heck fractures Ascending cervical arteries ⢠Feeder vessels arising from extracapsular ring ⢠Penetrate capsule ⢠Run parallel to femoral neck towards the head ⢠Lateral vessels provide greatest supply A major concern of femoral head and neck fractures is disruption of the arterial supply, which results in avascular necrosis. In fractures, the intraosseous cervical vessels are disrupted. Trueta J et al. J Bone Joint Surg BR 1953; Ly TV et al. J Boint Joint Surg Am 2008. Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References Lat. fem circumflex Med. fem circumflex Deep femoral art. Obdurator art.
- 8. Hip experiences combined mechanical loads ⢠Axial load along shaft, compressive stress ⢠Bending load along neck, tensile stress applied at upper neck and compressive stress at lower neck Cancellous bone arranged along principal lines of stress ⢠Primary medial trabeculae resist compression ⢠Primary lateral trabeculae resist tension Stress lines explain patterns of injury Wardâs Triangle: Weakest point of femoral neck Tensile groupCompressive group Wardâs Triangle Anatomy: Stress Lines Byrne DP et al. The Open Sports Medicine Journal 2010; Bowman KF Arthroscopy 2010. Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 9. Imaging Modalities Dominguez S et al. Acad Emerg Med 2005; Frihagen F et al. Acta Orthop 2005; Kirby MW et al. AJR Am J Roentgenol 2010; Khurana B et al. AJR 2012 Plain Film Radiography ⢠First line study ⢠90% sensitive, however 2-11% of ED patients have radiologically occult fractures ⢠AP and lateral radiographs of the hip ⢠AP radiograph of the pelvis, to assess for pelvic injury and compare with contralateral hip CT ⢠More readily accessible than MRI in acute ED settings ⢠Useful in trauma for detecting intra-articular extension, acetabular fracture, pelvic ring, and sacral fractures ⢠However, second-line compared to MRI because of concerns for missing fracture lines ⢠May be useful for preoperative evaluation Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References Coronal CT demonstrates a valgus impacted femoral neck fracture
- 10. Imaging Modalities Dominguez S et al. Acad Emerg Med 2005; Frihagen F et al. Acta Orthop 2005; Kirby MW et al. AJR Am J Roentgenol 2010 Khurana B et al. AJR 2012 MRI ⢠Obtain if radiographs are negative/equivocal and clinical suspicion is high ⢠More sensitive than CT for evaluating occult fractures ⢠Best for evaluating bone marrow, joint space, osteochondral injuries, early diagnosis and staging of AVN ⢠May be limited in access in an acute ED setting ⢠Technique: Useful MR sequences include the following: coronal STIR, coronal T1, axial dual-echo, axial T2 fat-saturated FSE, axial fat-saturated FSE proton density, sagittal T1, axial T1. ⢠Most useful sequences are coronal STIR (for edema) and coronal T1 (for fracture line) Bone Scan ⢠Indicated for suspected fracture or AVN not demonstrated on plain film, and where MRI unavailable ⢠High sensitivity, but poor specificity ⢠Minimum of 4 hours to perform, and may take up to 24-48 hours ⢠Relatively less useful in osteoporotic patients ⢠Poor spatial localization of fracture lines Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 11. Occult Femoral Neck Fracture Seen Only on MRI Dominguez S et al. Acad Emerg Med 2005 AP radiograph of the hip demonstrates no evidence of fracture. On coronal T1 MRI, a hypointense fracture line is present. Up to 11% of ED patients have radiologically occult hip fractures Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 12. Traumatic Femoral Head (Osteochondral) Fractures Traumatic femoral head fractures typically result from high energy impact, and are often associated with hip dislocations Posterior dislocations 9x more common than anterior Partial flexion, internal rotation typically leads to a posterior fracture-dislocation pattern Ross JR et al. Curr Rev Musculosk Med. 2012 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 13. Femoral Head Fractures: Pipkin Classification Posterior dislocation Fracture below fovea, non-weight-bearing Posterior dislocation Fracture above fovea, weight-bearing Associated femoral neck fracture Type I, II, or III, associated acetabular fracture Rockwood and Greenâs Fractures in Adults 2010; Ross JR et al. Curr Rev Musculosk Med 2012 Most commonly used classification for femoral head fractures, and used to guide operative versus nonoperative managementDisclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 14. Traumatic Femoral Head Fractures Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References Femoral head fracture with posterior dislocationFemoral head fracture with subfoveal involvement (Pipkin I)
- 15. Traumatic Femoral Head Fractures: Surgical Considerations Intra-capsular fracture, concern for avascular necrosis ⢠Emergent closed reduction as soon as feasible, preferably within 6 hours ⢠If irreducible, or with femoral neck fracture, then ORIF Above or below fovea? ⢠Above fovea, weight bearing ⢠Below fovea, non-weight bearing, could potentially be treated conservatively Is traction indicated? ⢠If fracture flipped, then traction indicated Congruent? ⢠If incongruent, then operative management Management Strategies ⢠Conservative management: Pipkin I ⢠ORIF: Pipkin II, Pipkin III, IV, irreducible fracture-dislocation ⢠Core decompression for osteonecrosis is controversial Rockwood and Greenâs Fractures in Adults 2010; Ross JR et al. Curr Rev Musculosk Med. 2012 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 16. Subchondral Insufficiency Versus Osteonecrosis Osteonecrosis ⢠Typically 30s-40s in age ⢠Associated with steroid/alcohol use ⢠50-70 percent bilateral MRI ⢠T1: Smooth band that is concave to the articular surface, and circumscribes necrotic segments Treatment ⢠No femoral head collapse: conservative treatment ⢠Femoral head collapse: THA or hemiarthroplasty Yamamoto T Clin Orthop Surg 2012; Ikemura S et al. AJR 2010 Subchondral insufficiency fractures are a recently recognized entity that may mimic osteonecrosis of the femoral head. However, certain clinical and imaging features will favor one diagnosis over the other. Osteonecrosis: coronal T1: bilateral decreased T1 signal in the femoral heads, and serpiginous bands concave to articular surface Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References A B Subchondral Insufficiency ⢠Biphasic pattern: elderly females and young active individuals ⢠Typically unilateral MRI ⢠Irregular, hypointense disconnected band that runs almost parallel to femoral head ⢠High signal proximal segment on C+ images Treatment ⢠No femoral head collapse ⢠Young: Trochanteric rotational osteotomy ⢠Elderly: THA or hemiarthroplasty Subchondral Insufficiency: coronal STIR (A) demonstrates irregular band parallel to the femoral head. Post-contrast T1 image (B) in a different patient demonstrates femoral head enhancement
- 17. Femoral Neck Fracture: Mechanism Caused by fall with applied force to the greater trochanter High energy impact in younger patients, and low energy impact in elderly patients Weakest site just below articular surface Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 18. Subcapital, Transcervical, Basicervical Fractures Transcervical Treated as intracapsular fx Basicervical Treated as extracapsular fx e.g. like intertrochanteric fx Subcapital Treated as intracapsular fx Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 19. Incomplete Valgus impaction + retroversion Complete, non-displaced Marked angulation Minimal/no proximal translation Complete displacement Proximal translation Commonly used classification for surgical management of femoral neck fractures Valgus impacted fractures are often missed Good interobserver agreement between I-II and III-IV, but poor between all groups Better to distinguish I-II and III-IV, as types III and IV typically treated with arthroplasty IVIII I II Garden Classification Frandsen PA et al. Acta Orthop Scand 1984; Kreder HJ J Bone Joint Surg AM 2002 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 20. Pauwel Classification Type I More stable Type III More unstable, higher energy injury Determined by angle of fracture from horizontal plane Increased shear forces with increased angles worsens prognosis Better categorizes stability than the Garden Classification Better predicts difficulty of obtaining stable fixation More vertically oriented fractures may also require plate fixation Type III fractures complicated by nonunion may require intertrochanteric osteotomy to reorient the fracture line to a more Type 1 (stable) angle Ly TV et al. J Bone Joint Surg Am 2008 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References Type II Most common
- 21. Types of Stress Fractures Tensile Unstable, fracture can propagate Compressive More stable Displaced Unstable Worse prognosis and risk for avascular necrosis Emergent operation and reduction Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References Femoral neck stress fractures are often related to increased activity. The pattern of the stress fracture relates to the lines of stress within the proximal femur and has significant management implications
- 22. Tensile Stress Fracture Superior, lateral aspect of the femoral neck Bimodal distribution: Elderly individuals and young runners Potentially unstable, obtain MRI to assess fracture extent Warrants internal fixation (nail fixation in young athletes) Femoral Neck: Tensile Stress Fracture Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 23. Femoral Neck: Tensile Stress Fracture Tensile stress fracture in the superolateral femoral neck in an elderly patient. Note osteoarthritis of the hip. Tensile stress fracture (Garden III) in the superolateral femoral neck in a young, active, patient. Note the normal bone mineral density. Bimodal distribution: elderly individuals and young runners Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 24. Femoral Neck: Fatigue Compression Fracture Fatigue Compression Fracture Inferior aspect of femoral neck Active individuals May potentially be treated non-operatively Coronal STIR image demonstrates edema at the inferomedial femoral neck. Coronal T1 image demonstrates a hypointense region and a subtle fracture line. Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 25. Femoral Neck Fractures: Surgical Considerations AVN, nonunion may result from delayed diagnosis ⢠Risk for AVN is greater for femoral neck fractures than for pertrochanteric fractures Young ( < 65) and/or active ⢠Goal: preserve femoral head, avoid osteonecrosis, achieve union Old ( > 75) and/or immobile ⢠Goal: restore mobility and minimize complications Fracture pattern determines treatment ⢠Basicervical fracture treated like intertrochanteric fracture ⢠Nonoperative management associated with higher complication and increased risk of displacement ⢠If nondisplaced, internal fixation preferred ⢠If displaced fracture, elderly, arthroplasty preferred ⢠Most studies find improved function with THA compared to hemiarthroplasty Miler BJ et al. J Bone Joint Surg Am 2013; Goh SK et al. J Arthroplasty 2009; Cserhati P et al. Injury 1996 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 26. Femoral Neck Fracture: Treatment Algorithm Nondisplaced Displaced Total Hip Arthroplasty Hemiarthroplasty OldYoung PC Screw or ArthroplastyPercutaneous Cancellous (PC) Screw Miler BJ et al. J Bone Joint Surg Am 2013 Open Reduction Internal Fixation Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 27. Intertrochanteric Fracture Koval KJ et al. J Am Acad Orthop Surg 1994 Nondisplaced Intertrochanteric fracture (Evans I) Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References Anatomy ⢠Intertrochanteric line: anterior ridge between greater and lesser trochanters ⢠Extracapsular, transition between femoral neck and shaft ⢠Iliofemoral ligament attaches above, vastus medialis attaches below Mechanism ⢠Resulting from fall Unstable features ⢠Loss of medial buttress ⢠4-part fractures, and 3-part fractures with lesser trochanter involvement ⢠Reverse obliquity ⢠Comminution Stable features ⢠Near anatomic reduction achievable ⢠Lesser trochanter nondisplaced ⢠Medial cortices in alignment ⢠No comminution
- 28. Evans Classification Trafton PG. Orthop Clin North Am 1987; Koval KJ et al. J Am Acad Orthop Surg 1994 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References I II III Two part, undisplaced Stable Two part, displaced Stable Three part, posterolateral comminution Unstable Three part, posteromedial comminution Unstable Four Part Unstable Useful for deciding stability and treatment of intertrochanteric fractures. Also, reverse obliquity fractures are unstable and treated like subtrochanteric fractures IV V
- 29. Intertrochanteric Fracture: Management Incomplete ⢠Obtain MRI to ensure fracture not complete ⢠If incomplete and <50% fracture width, potentially can treat conservatively ⢠Risk of fracture completion Complete ⢠Stable: Dynamic plate and screw ⢠Unstable or reverse obliquity: Intramedullary device Management depends on completeness and stability Risk of AVN and nonunion less than in femoral neck fractures Again, basicervical fractures treated like intertrochanteric fractures Su BW, Orthopedics 2006; Forte ML et al. J Bone Jint Surg Am 2008 Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 30. Greater Trochanter Fracture Anatomy ⢠Greater trochanter is the insertion site for hip abductors (gluteus medius and minimus) and external rotators (piriformis, gemelli, obdurators) Mechanism ⢠Isolated greater trochanter fracture may be related to impaction from fall, versus avulsion Imaging ⢠If incomplete, obtain MRI to assess extent of fracture Management ⢠Most heal well with nonoperative management ⢠If significant displacement, then ORIF Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 31. Lesser Trochanter Fracture Anatomy ⢠Lesser trochanter is attachment site for iliopsoas Mechanism ⢠Fracture may be due to avulsion ⢠In the absence of injury, isolated lesser trochanter fracture is highly suspicious for an underlying malignancy Imaging ⢠Obtain MRI to assess extent of fracture ⢠Evaluate for underlying malignancy Management ⢠Nondisplaced fractures heal well with nonoperative management ⢠If significantly displaced, then ORIF James SL et al. Eur Radiol 2006 Mildly displaced lateral trochanter fracture in a patient with prostate cancer and diffuse blastic metastases. Also note the extensive periosteal reaction. Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 32. Subtrochanteric and Proximal Femoral Shaft: Traumatic Versus Atypical Fractures Shane E et al. J Bone Miner Res 2010. Park-Wyllie LY et al. JAMA 2011 Atypical Fractures Long-term bisphosphonate usage, o/minimal trauma Imaging Typically subtrochanteric or femoral shaft Transverse or short oblique orientation Lateral beaking (arrow) Normal bone mineral density Management Evaluate contralateral femur Treat with ORIF, intramedullary nail and screw0 It is important for the radiologist to recognize the different patterns of traumatic and atypical subtrochanteric and proximal shaft fractures Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References Typical Fractures Often traumatic, high impact Imaging Radiographs generally diagnostic Oblique or spiral in orientation Proximal piece is flexed, abducted, and externally rotated MR/CT if concern for pathologic fracture Management ORIF Higher rates of failure due to high stress anatomy
- 33. Conclusion ⢠Proximal femoral fractures can be classified as femoral head, intracapsular, and extracapsular ⢠Increased concern for AVN and nonunion for intracapsular fractures due to vascular compromise ⢠Important to understand how imaging features reflect underlying mechanical forces and mechanisms of injury, and how these in turn guide management ⢠If a patient has hip pain and negative x-rays, strongly consider further imaging with MRI Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
- 34. References ⢠Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br. 1953;35:442-61 ⢠Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am. 2008;90:2. 254-66 ⢠Byrne DP et al. The Open Sports Medicine Journal 2010;4;51-7. ⢠Bowman KF Jr, Fox J, Sekiya JK. A clinically relevant review of hip biomechanics. Arthroscopy 2010;26(8):1118-29. ⢠Dominguez S, Liu P, Roberts C et al. Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographsâa study of emergency department patients. Acad Emerg Med 2005;12(4):366-9. ⢠Frihagen F, Nordsletten L, Tariq R, et al. MRI diagnosis of occult hip fractures. Acta Orthop 2005;76(4):524-30. ⢠Kirby MW, Spritzer C. Radiographic detection of hip and pelvic fractures in the emergency department. AJR Am J Roentgenol 2010;194(4):1054-60. ⢠Khurana B, Okanobo H, Ossiani M, et al. Abbreviated MRI for patients presenting to the emergency department with hip pain. AJR Am J Roentgenol 2012;198(6):581-8. ⢠Ross JR, Gardner MJ. Femoral head fractures. Curr Rev Musculoskelet Med 2012;5(3):199-205. ⢠Rockwood and Greenâs Fractures in Adults, 7th Edition. Wolters Kluwer/Lippincott Williams & Wiilkins, New York, 2010. ⢠Yamamoto T. Subchondral insufficiency fractures of the femoral head. Clin Orthop Surg. 2012:4(3):173-80. ⢠Ikemura S, Yamamoto T, Motomura G, et al. MRI evaluation of collapsed femoral heads in patients 60 years old or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. AJR Am J Roentgenol 2010;195:W63-W68. ⢠Frandsen PA, Andersen PE Jr, Christoffersen H et al. Osteosynthesis of femoral neck fracture. The sliding-screw-plate with or without compression. Acta Orthop Scand 1984;55(6):620-3. ⢠Kreder HJ. Arthroscopy led to fewer failures and more complications than did internal fixation for displaced fractures of the femoral neck. J Bone Joint Surg Am 2002;84:2108. ⢠Miller BJ, Lu X, Cram P. The Trends in Treatment of Femoral Neck Fractures in the Medicare Population from 1991 to 2008. J Bone Joint Surg Am 2013:95(18):1-8. ⢠Goh SK, Samuel M, Su DHC et al. Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced neck of femur fracture. J Arthroplasty. 2009:24(13):400-6. ⢠Koval KJ, Zuckerman JD. Hip fractures, II: evaluation and treatment of intertrochanteric fractures. J Am Acad Orthop Surg 1994;2(3):150-6. ⢠Trafton PG. Subtrochanteric-intertrochanteric femoral fractures. Orthop Clin North Am 1987;18(1):59-71. ⢠Su BW, Heyworth BE, Protopsaltis TS et al. Basicervical versus intertrochanteric fractures: an analysis of radiographic and functional outcomes. Orthopedics 2006;29(10):919-25. ⢠Forte ML, Vimig BA, Kane RL. Geographic variation in device use for intertrochanteriic hif fractures. J Bone Joint Surg Am 2008;90(4):691-9. ⢠James Sl, Davies Am. Atraumatic avulsion of the lesser trochanter as an indicator of tumour infiltration. Eur Radiol. 2006;16(2):512-4 ⢠Shane E, Burr D, Ebeling PR et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society of Bone and Mineral Research 2010; 25(11):2267-94 ⢠Park-Wyllie LY, Mamdani MM, Juurlink DN. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 2011;305(8):783-9. ⢠Tornetta P III. Subtrochanteric femur fracture. J Orthop Trauma 2002;16(4);280-3 Thank You For Viewing Our Exhibit â Jeffrey Shyu (jshyu@partners.org) Disclosures Learning Objectives Organization Anatomy Imaging Osteochondral Subchondral Femoral Neck Intertrochanteric Greater Troch. Lesser Troch. Subtrochanteric Conclusion References
Hinweis der Redaktion
- Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br. 1953;35-442-61 Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am. 2008;90:2. 254-66
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- 24877631 F01136644 03233905 20025920
- chart Miller BJ, Lu X, Cram P. The Trends in Treatment of Femoral Neck Fractures in the Medicare Population from 1991 to 2008. J Bone Joint Surg Am 2013:95(18):1-8. Goh SK, Samuel M, Su DHC et al. Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced neck of femur fracture. J Arthroplasty. 2009:24(13):400-6. Cserhati P, Kazar G, Manninger J, Fekete k, Frenyo S. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury 1996;27;8:583-8.
- Miller BJ, Lu X, Cram P. The Trends in Treatment of Femoral Neck Fractures in the Medicare Population from 1991 to 2008. J Bone Joint Surg Am 2013:95(18):1-8. Sliding hip screw for nondisplaced fx
- F00495342 Su BW, Heyworth BE, Protopsaltis TS et al. Basicervical versus intertrochanteric fractures: an analysis of radiographic and functional outcomes. Orthopedics 2006;29;10:919-25.
- James Sl, Davies Am. Atraumatic avulsion of the lesser trochanter as an indicator of tumour infiltration. Eur Radiol. 2006 16(2):512-4
- Park-Wyllie LY, Mamdani MM, Juurlink DN. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 2011;305(8):783-9.